Cleary's editorial is in response to a new report from the International Narcotic Control Board (INCB) on this inequity. The study showed that while access to opioids improved in most high-income countries – the United States, Canada, western Europe and Australia – there was no change in much of Africa and Asia.

"For 50 years, the primary result of the actions, or lack thereof, of the global drug-control mechanism has been to restrict access to these indispensable and essential medicines,'' writes Cleary, who is a UW Health medial oncologist and palliative care specialist, director of the UW Carbone's Cancer Center's Pain and Policy Studies Group (PPSG) and a leader of the Global Opioid Policy Initiative (GOPI).

Cleary and his PPSG colleagues say that these countries need to address:

Policies and regulations governing the use of opioid medicines

The availability and accessibility of these medicines

Education of clinicians and the public on their use

Education is needed in the United States as well, Cleary writes, given growing problems with opioid addiction and overdose deaths. In this country, increased opioid availability has been associated with the illicit provision of opioids (pill mills). Methadone, an opioid with a very long half-life and one in which most clinicians have little training, is associated with one-third of the "opioid-associated" deaths.

"We have a major public health problem related to opioids in the U.S.,'' Cleary says. "But in order to create a meaningful public health response and restore balance in their use, we need to fully understand the problem. Methadone is an example of this. Most physicians have little understanding of this complex medicine, yet are being mandated by states and health care systems to use it. Pain patients who benefit from opioids for pain relief should not be asked to carry the burden of this crisis. We are already seeing situations where the access of U.S. cancer and hospice patients to pain relief is being impaired, similar to situations in the rest of the world."

Cleary writes that the Global Opioid Policy Initiative's next steps to improve access include the following recommendations:

WHO and non-governmental organizations should support member states to implement the WHO Palliative Care resolution

Individual governments should evaluate their regulatory structures for over-regulation and undertake the necessary legislative and regulatory reforms to ensure accessibility to essential pain-relieving medications.

Pain and palliative-care advocates should continue to engage with international and regional organizations within civil society to provide powerful support for their advocacy with national regulatory authorities.

"Our goal is to bring about balance - ensuring access to those who need opioids for medical purposes while reducing the risk of misuse and diversion," Cleary says. "Member states and other funding bodies, especially those with sufficient access to opioids, need to provide financial resources to UN organizations, and to civil society to bring about these changes ultimately to reduce pain and suffering around the world. "